| ObjectiveViscera doctrine is the basic theory of traditional Chinese medicine.The spleen is acquired.Its main physiological function of“the spleen masterring muscle" is a hot field of basic subjects of TCM research.When the movement of spleen qi is normal,the muscle fullness and limbs powerful;when spleen asthenic,the muscle wasting,limbs tired and weak,even paralysis waste not.Mitochondria is a substance and energy metabolism and genetic variation in the form of three basic activities of life into one of the semi-autonomous organelles,called“the power factory of the cell",which can provide energy needed for the body.Therefore,the theory of“the spleen masterring muscle" is closely related to the modern medicine mitochondrial function in the material and energy metabolism.Spleen asthenic is a common syndrome in Chinese medicine.Many scholars have been starting study from experiment,clinic and spleen asthenic etc since the 1990s.This study includes clinical research and experimental research.The clinical research is cases review on myasthenia gravis,which is under the Deng lao's guidance of“Spleen asthenic,the five internal organs related "and base on the opinion of standing in the spleen and stomach,tonifying deficiency and profiting loss,the curative effect of strengthening spleen and invigorating qi were to observed,then the current situation of diagnoses and trmeament of myasthenia gravis was to summarized.Experimental research replicate spleen asthenic animal models,from the perspective of mitochondrial energy metabolism,by observing the rat skeletal muscle mitochondrial COXImRNA,COXIVmRNA protein expression changes,delving into the mechanism spleen asthenic energy metabolism,observing the effect of strengthening spleen and invigorating qi provide guidance for clinical practice.Methods1.Review on clinical myasthenia gravis studyThe cases of myasthenia gravis electronic medical records from January 2011 to December 2014 of the first affiliated hospital of Guangzhou University of Chinese medicine were to referred to,collected spleen asthenic MG(I type,?a type,?b type)149 cases,using review approach to investigate and analysis the clinical data(such as age,sex,the causation,incentives,course,the first symptom and treatment etc).The statistic analyses were used SPSS19.0 to carry out,through observing the effect of strengthening spleen and invigorating qi on myasthenia gravis,then the current situation of diagnoses and trmeament of myasthenia gravis was to summarized.2.Animal experimental research42 SD.SPF rats were randomly divided into two groups,namely,the normal group 10,model group 32.The rats in model group were given abdominal subcutaneous injection of reserpine 0.5mg/kg/d,while the rats in normal group were given equal quantity normal saline for 8 days.Recorded the general condition of rats,D-xylose urine excretion rate in order to determine whether the spleen asthenic rat model was successfully established.Model group appeared to reduce food intake,significant weight loss,like get together,loose stool and D-xylose excretion rate decreased other changes,proved successful modeling.Using a random number table,randomly selected 7 normal rats and 14 rats in model group.The successful model rats were randomly divided into Si jun zi decoction group and spleen asthenic group,each group 7.Treatment group were given si jun zi decoction,as well as spleen asthenic group and normal group were given normal saline.To measure Urea D-xylose excretion rate after 3 weeks and evaluate condition of spleen asthenic rats,by Urea D-xylose excretion rate.After 3 weeks of the treatment,investigated D-xylose urine excretion rate.Extraction of skeletal muscle and liver tissue,routine,using HE staining observe its pathological changes;Extraction of skeletal muscle mitochondria,PCR method was used to detect the expression of skeletal muscle mitochondrial COXImRNA,COXIVmRNA,immunohistochemistry method to observe the skeletal muscle cells of rat COXI,COXIV protein expression and the effect of Si Jun Zi Decoction on the changes of above indexes.Results1.Review on clinical study1.1 In in-patient of myasthenia gravis,the male female ratio was 1:1.64.The average age was 39.81±17.16 years.The morbidity peak lied between age 31 to 50.65.38%of the patients' course were below 5 years.Most of them belonged to midrange generalized type.1.2 Predisposing factors with no significant incentives(79.19%),fatigue(11.41%)and cold(8.54%)were more common,which manifest avoiding fatigue,prevention of infection,paying attention to keep warm played an important role for myasthenia gravis control and recovery.Eye(single or double)is the first onset of symptoms in the first symptom,which were 100 cases,accounting for 67.12%.1.3 Myasthenia gravis patients with tongue.pulse to pale tongue and thin pulse were most common,which reflected the deficiency of spleen and stomach was its main pathogenesis.1.4 The traditional Chinese medicine showed that Radix Fici Hirtae,Atractylodes,licorice,astragalus,Poria cocos were commonly used in clinical medicine of the treatment of MG.That is,paying attention to the use of strengthening spleen and invigorating qi,supplementing by ascending,dampness,regulating qi,tonifying kidney drugs,which consistented the analysis of the main pathogenesis of myasthenia gravis.2.Animal experimental research2.1 After the injection,there was a significant difference between normal group and model group in body weight(p<0.01).However,Si jun zi decoction group body weight was still lower than normal group(p<0.01).After 3 weeks by mouth,urinary D-xylose excretory rate in Si jun zi decoction group was recovered(P>0.05),there was an upward trend in body weight between Si jun zi decoction group and spleen asthenic group,the two groups showed no significant difference(P>0.05).But there was a significant difference between normal group and spleen asthenic group(P<0.01).2.2 Pathological changes in rat skeletal muscle:Compared with the normal group,spleen asthenic rats skeletal muscle fibers arranged in disorder,the gap increased and muscle cell cytoplasm of uneven dyeing,uneven distribution of the nucleus.Compared with spleen asthenic group,the Si Jun Zi Decoction group of skeletal muscle fibers arranged neatly,which showed that Si Jun Zi Decoction group,the pathology of skeletal muscle injury had been improved.2.3 Pathological changes in liver tissue:Compared with the normal group,spleen asthenic group partly dissolved necrosis of liver cells,liver sinus congestion,liver cable structure is not clear.Compared with spleen asthenic group,the Si Jun Zi Decoction group,which hepatic cord arranged in neat rows and liver sinus blood stasis reduced,showed that Si Jun Zi Decoction can repair the spleen liver damage in structures.2.4 Compared with normal group,the expression of skeletal muscle mitochondrial COXImRNA,COXIVmRNA in spleen asthenic rats decreased(P<0.05).Compared with spleen asthenic group,the expression of skeletal muscle mitochondrial COXImRNA,COXIVmRNA in Si Jun Zi Decoction group increased(P<0.05).2.5 Compared with normal group,the expression of skeletal muscle in spleen asthenic group,COXI,COXIV protein decreased(P<0.05).Compared with spleen asthenic group,the expression of COXI,COXIV protein in Si Jun Zi Decoction skeletal muscle increased(P<0.05).Conclusion1.Myasthenia gravis patients with tongue?pulse to pale tongue and thin pulse were most common.The traditional Chinese medicine showed that Radix Fici Hirtae,Atractylodes,licorice,astragalus,Poria cocos were commonly used in clinical medicine of the treatment of MG.That is,paying attention to the use of strengthening spleen and invigorating qi,supplementing by ascending,dampness,regulating qi,tonifying kidney drugs,which consistented the analysis of the main pathogenesis of myasthenia gravis.2.The reserpine induced spleen asthenic requires spleen asthenic rat model by observing general condition and urinary D-xylose excretory rate.Spleen asthenic model rats skeletal muscle,liver pathological injuried.Through the treatment of Si Jun Zi Decoction,skeletal muscle and liver pathological injury were improved,showed that the Si Jun Zi Decoction could repair the pathological structure of spleen deficiency model rats.3.Expression of spleen asthenic model rats skeletal muscle mitochondrial COXImRNA,COXIVmRNA and protein were decreased.By the treatment of strengthening spleen and invigorating qi,the expression of COXImRNA,COXIVmRNA and protein were increased,showed that spleen asthenic exists when skeletal muscle mitochondria energy metabolism disorder and Si Jun Zi Decoction can obviously improved the cell energy metabolism. |
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